Denial of multiple units of lesion excision (same CPT)

lwcarter

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Oswego, IL
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We've recently started to see denials for excisions (same CPT) on the same claim. For example, 11403 x 3 units.
Sometimes 1 unit will pay and other times none will pay with a message that the modifier used is incorrect or missing.
We were able to get these paid until now with -76-59 on the 2nd and 3rd unit
We've tried XS and 59 and neither of these modifiers get the claims paid currently.
I've researched on CMS and am not finding a new policy.
Any insight on a modifier that will work?

Thank you.
 

JesseL

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We've recently started to see denials for excisions (same CPT) on the same claim. For example, 11403 x 3 units.
Sometimes 1 unit will pay and other times none will pay with a message that the modifier used is incorrect or missing.
We were able to get these paid until now with -76-59 on the 2nd and 3rd unit
We've tried XS and 59 and neither of these modifiers get the claims paid currently.
I've researched on CMS and am not finding a new policy.
Any insight on a modifier that will work?

Thank you.
You do not use units when billing the same excision codes.. at least I've never done it that way.

You bill it as such:

11403 1 unit
11403-59 or XS 1 unit
11403-59 or XS 1 unit

I don't think the modifiers are necessary since there's no NCCI conflict but I use them on the safe side.. I never used the new modifiers actually.
 

mdeanne

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Portland, OR
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MUEs may be in play here

We've recently started to see denials for excisions (same CPT) on the same claim. For example, 11403 x 3 units.
Sometimes 1 unit will pay and other times none will pay with a message that the modifier used is incorrect or missing.
We were able to get these paid until now with -76-59 on the 2nd and 3rd unit
We've tried XS and 59 and neither of these modifiers get the claims paid currently.
I've researched on CMS and am not finding a new policy.
Any insight on a modifier that will work?

Thank you.
Hello-I looked up the CPT code 11403. It has 2 for MUE. So, theoretically 11403 1 unit, 11403-76 (or XS depending on your MAC), and 11403-76 would be billed and the third would deny. With Medicare you would have to send in a redetermination showing your provider did perform this many units.
Hope that helps.
MDeanne, CPC-D
 
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